Lucky Dip, Cardio, Derm, Endocrine Flashcards
What happens during apoptosis?
The cell shrinks and condenses.
The cytoskeleton collapses, the nuclear envelope disassembles, and the nuclear DNA breaks up into fragments.
Details: Translational Pathology Class Chapter 2 part 4
What is the mechanism for PUPD with hypercalcemia?
This is a direct effect of hypercalcemia on the concentrating ability of the kidney; however, hypercalcemia can also cause acute or chronic renal failure, also resulting in PU/PD.
What is the most common cytokine released by NK cells
Interferon gamma
Review: Anion gap, metabolic and respiratory acidosis and alkylosis
https://www.youtube.com/watch?v=sQnEFVNrY74
https://www.youtube.com/watch?v=w3nsxx6AcdA
What is CPV2b? What does is cause in pregnant pigs/cats/dogs?
Parvovirus
Pig: abortion, Dog: myocarditis, cat Cerebellar hypoplasia
How does phenylpropanolamine work? What is the brand name of this drug?
Proin
Indirectly stimluates the alpha 1 adrenergic receptors (and to a lesser extent beta receptors) by causing release of norepinephrine leading to consitration of the smooth muscle of the internal urethral sphincter.
What are the mechanisms of action of calcitonin and calcitriol?
Calcitonin decreases calcium levels by blocking the breakdown of bone calcium and by preventing your kidneys from reabsorbing calcium. Calcitriol, increases calcium absorption from the intestine.
What is a definitive test for a PTE?
a) d dimer
b) TEG
c) CT/angiogram
d) MRI
CT/angiogram
What blood group in dogs can cause hemolysis when transfused?
DEA 3, 5, and 7
What breed gets DCM associated with taurine deficiency?
a) golden retriever
b) Dalmatian
c) Doberman
d) Cocker Spaniel
Cocker Spaniel
What type of fluid should you give to a cat in DKA?
a) norm R
b) saline
c) plasmalyte
d) LRS
Balanced electrolyte solution that is not LRS (so Norm R and Plasmalyte would be good options).
With a left or right ventricular septal defect should you expect volume overload? Pressure overload?
L to R VSD - volume overload
R to L VSD - pressure overload
Initially, there is a large left-to-right shunt with volume overload of the left and right ventricles. Over time, the large shunt causes elevated pulmonary artery vascular resistance with increased right ventricular pressure overload and right ventricular hypertrophy
What type of AV block responds to atropine?
An appropriate response to atropine suggests a vagally-mediated bradyarrhythmia. (typically first or second degree (type 1).
An incomplete or absent response to atropine, supports the diagnosis of primary or secondary disease of the SA node or AV node.
What drug should be prescribed for AV block with positive atropine test?
a) sotolol
b) propanthaline
c) propanolol
d) lidocaine
o Lidocaine – class 1b anti-arrhythmic (fast Na channel blocker, shortens action potential)
o Propranolol – class 2 anti-arrhythmic (B-blocker)
o Sotalol – class 2/3 anti-arrhythmic (B-blocker and K channel blocker)
o PROPANTHALINE – antimuscarinic drug with similar actions as atropine
Indications: Used to treat vagal-mediated bradycardia, sinus arrest with sick sinus syndrome, and perhaps heart block. Can be used for chronic therapy, especially if atropine response test is positive.
Reference: https://sites.tufts.edu/cardiorush/cardiology-drug-formulary/
What happens during S3?
Review: All heart sounds and what happens
Ventricular filling
What reaction is catalysed by carbonic anhydrase?
What does it do in the body?
What is the chemical formula of carbonic acid and bicarbonate?
Converts the metabolic product CO2 to carbonic acid, H2CO3, in the red blood cells for transport to the lungs. When red blood cells reach the lungs, the same enzyme helps to convert the bicarbonate ions back to carbon dioxide, which we breathe out. In the human form it contains the metal ion Zinc as a key component. The zinc is bonded to three nitrogen atoms in three histidine amino acids in the protein.
Carbonic acid = H2CO3
Bicarbonate = HCO3-
Fun Fact: Carbonic anhydrase aids in the regulation of fluid and pH balance and is involved in producing essential stomach acid. The enzyme also plays a role in vision. When it is defective, fluid can build up and cause glaucoma. The enzyme is one of the fastest known, catalyzing up to one million reactions per second.
Review: Shifts in the O2 Hgb curve
- The right hand symbolizes giving
- With left shift the tissue is left behind
What immunoglobulin would you be most likely to find in the upper airway?
IgA
Where is apotransferrin located? Where is apoferritin located?
Apotransferrin is transferrin before it is bound to Fe3+ which moves through circulation to BM or Liver. Apoferritin is before iron binds it and is located in the cell for iron storage.
With an anticoagulant rodenticide toxicity, what test is the most reliable? Which are the vitamin K dependent factors?
a) buccal bleeding test
b) ACT
c) PT
d) PTT
e) PIVKA
Which test changes first? Why?
PT/PTT
Vitamin K dependent = 2, 7, 9, 10
PT changes first because factor 7 has the shortest halflife so you will see a problem in the extrinsic pathway before the intrinsic pathway which is tested for by PTT
When should you start clopidogrel for a cat with proteinuria?
Clopidogrel should be considered once you have confirmed proteinuria in the cat as it is at increased risk for thromboembolic disease. PLN specifically?
What is the RBC lifespan in circulation for a cat? Dogs?
70-80 days
110-120 days
Where are chief cells located and what do they secrete?
In the stomach and secrete pepsinogen.
Is it possible for staph aureus to be transmitted from horses to people?
Yes, it is zoonotic. Can also be given to people by dogs.
In what congenital cardiac condition would you see a notched QRS complex?
Tricuspid valve dysplasia
What are the most common causes of pulmonary hypertension? What congenital abnormalities cause pulmonary hypertension?
- secondary to heartworm, PTE, severe hypoxemia (d/t primary pulmonary disease), and left sided heart failure.
- Ventricular septal defect and patent ductus arteriosis b/c they increase pulmonary bloodflow
What is and what is the most common adverse effect of oclacitinib?
a) bone marrow suppression
b) diarrhea
c) facial excoriations
Apoquel
b) GI upset/diarrhea
What muscles of the eye/face are innervated by CN3?
Oculomotor
- innervation of th pupil/lens, eupper eyelid, and eye muscles that allow for visual tracking
Question where they list clinical signs and ask which toxin caused them. Some options were
a) marijauna toxicity
b) aflatoxin
a) Neurological, dribbling urine
b) liver - neuro, GI, icterus, bleeding
What medication do you use if there are cardiac complications with a pheochromocytoma?
??????α-adrenergic blocking agents, β-adrenergic blocking agents, captopril, and calcium channel blockers. Captopril is an angiotensin-converting enzyme inhibitor and may also act to scavenge free radicals, which have been shown to contribute to the pathology of catecholamine-induced cardiomyopathy. Calcium channel blockers are useful in the treatment of catecholamine-induced cardiomyopathy in that they minimize coronary vasospasm and myocarditis
Why does effusion form in cats with FIP?
FIP infected monocyftes release VEGF
Tentanus antitoxin binds with what form of tetanus toxin in the body?
Free toxin
Patient presents with an abdominal mass and is hypoglycemic. If it is not an insulinoma, what is the most likely tumor?
Leiomyosarcoma
FIV results in decreased numbers of what cell type?
CD4 T cells
How does metronomic chemotherapy work?
Antiagniogenesis
What lipoprotein contains the highest cholesterol content?
Review: content in all lipoproteins
HDL
Explain fluid in the body:
What are the main electrolytes of the intracellular and extracellular fluid?
Broken down into 33 % extracellular (20% plasma, 80% interstitial) and 66% intracellular.
Na+ and Cl - are main extracellular fluid cation and anion
K+ and PO4- are the main intracellular fluid cation and anion.
Bonus: Bicarb also present and important in acid/base balance.
What do alpha cells of the pancreas secrete?
They secrete glucagon as a response to low blood glucose.
Patient requires a diuretic and has low potassium, which should you use?
Spironolactone
In nephrogenic diabetes insipidis do you get hyper or hyponatremic?
Hypernatremia b/c the body is producing too much urine and so you can get very dehydrated.
Review: IgG and IgM in toxo diagnosis
High levels of IgG antibodies to T. gondii in a healthy cat suggest that the cat has been previously infected and is most likely immune to the organism and not excreting oocysts. These cats are no longer sources of infection for other hosts. High IgM antibody levels, in contrast, suggest an active infection.
What antibiotic concentrates in urine?
Amoxicillin (clavulonic acid not thought to add anything since there is some hepatic metaboslism and excretion).
Cephalexin
TMPS
What is the most specific test for pancreatitis?
a) TLI
b) Vetscan cPL rapid test
c) AUS
d) Precision PSL
e) SNAP cPL
f) Spec cPL
VetScan cPL rapid test
Untreated Addison’s can result in what bloodwork changes?
Low sodium (d/t cortisol and aldosterone deficiency)
and high potassium
Can also see hypoglycemia
Addisonion crisis!
What is triiodothyronine?
T3
Review: Neuro: L and R forebrain, cerebellum lesions
What is a high SDMA most representative of?
Impaired GFR - initially thought to be a better marker than serum creatinine but this may not be true based on more recent studies mostly due to low specificity.
Which of the following is a major acute phase protein in a cat? minor?
a) C reactive-protein
b) Ceruloplasmin
c) haptoglobulin
d) Serum amyloid A
e) Alpha 1 acid glycoprotein
Serum amyloid A
c and e
A cat with ventroflexion and neurologic signs, what vitamin deficiency is present?
a) B1
b) E
c) A
d) K
Vitamin B1 - thiamine
What are the essential amino acids in cats and dogs and which one is only an essential amino acid in cats?
Arginine
Histidine
Isoleucine
Leucine
Lysine
Methionine
Phenylalanine
Taurine - cats
Threonine
Tryptophan
Valine
Which type of fat is essential for dogs?
Linoleic
Intralipids are the best treatment for which of the following toxins?
a) Ivermectin
b) teatree oil
Ivermectin
With EPI, what changes on GI panel are you most likely to see?
Increased PLI, increased TLI, decreased folate, decreased vitamin B12
What type of hypersensitivity reaction is IMHA?
Type 2
Pseudohyperkalemia is seen with which bloodwork change?
Thrombocytosis
What is the cause of increased lipidemia in Schnauzers?
In Miniature Schnauzers, hyperlipidaemia often occurs due to genetic factors, whereby the the body’s ability to metabolize lipids is affected. Of the two main fats, triglycerides have been shown to be more important than cholesterol in dogs.
What is the most common change to see on a chemistry in a cat with hyperthyroidism?
85% of cats have a mild to moderately elevated ALT
IN DIC, what is released from the endothelium?
Tissue factor
What is the diagnosis for a cat with 12 days of lethargy and a reduced appetite, high ALT, very high ALP, very high Tbili, high cholesterol, and high triglycerides?
a) acute cholangiohepatitis
b) hepatic lipidosis
c) cancer
d) pancreatitis
cholangiohepatitis?
Is entyce a ghrelin receptor antagonist or agonist?
Ghrelin receptor agonst. Growth hormone is
What is a biomarker for stretch in cats?
a) pro - BNP
b) ANP
c) troponin I and C
pro - BNP
What is the treatment of choice for boxer granulomatous colitis?
a) tylosin
b) steroid
c) enrofloxacin
d) metronidazole
C) enrofloxacin
A dog treated with desmopressin is at risk for what electrolyte abnormality?
hyponatremia
There is a female cat with a stone in her ureter, 2 small kidneys, bilateral pyelectasia, and ureteral dilation proximal to the stone. If the cat has already been treated with fluids, buprenorphine, amlodipine. What is the next step?
a) SUB
b) fluids and tamsulosin
Bilateral sub?
What is the MofA of organophosphates?
Act as inhibitors of the enzyme acetylcholinesterase, leading to excess neurotransmitter acetylcholine (ACh). This surplus of ACh in the body leads to the manifestation of symptoms associated with the cholinergic toxidrome.
Cholinergic toxidrome - Acetylcholine accumulation at muscarinic receptors produces an increase in secretions which can manifest as bronchorrhea, salivation, tearing and sweating, bronchoconstriction, tightness in the chest, wheezing, bradycardia, vomiting, increased gastrointestinal motility, abdominal tightness, diarrhea, and cramps
What do you do after surgery to prevent more calcium oxylate stones from forming?
a) drink more water
b) acidify urine
c) increase dietary protein
d) Give vitamin C supplement
A
- note: The main goals of dietary modification are to decrease calcium concentration in the urine, to decrease oxalate concentration in the urine, to promote high concentration of crystal formation inhibitors in the urine, and to decrease urine concentration. Dietary protein should be restricted to 10% to 18% on a dry matter basis (DM). Higher levels of protein intake have been shown to significantly increase urinary calcium and oxalate excretion (2,5). Dietary sodium should be restricted to < 0.3% DM, because urinary sodium excretion is directly correlated with urinary calcium excretion, such that increasing the excretion of one leads to an increase in excretion of the other (2,5). This includes avoiding table scraps and commercial pet treats that tend to be high in sodium. Dietary calcium should be restricted to between 0.3% and 0.6% DM (2,5). Reducing dietary calcium to these levels reduces the chance of excessive absorption and excretion of calcium (2). Vitamin D and vitamin C supplements should be avoided, since the former will enhance intestinal absorption of calcium and the latter serves as a precursor for oxalate (2,4). Diets that promote relatively alkaline urine (pH 6.8 to 7.0) are encouraged to minimize oxalate crystal formation. Lastly, water should be provided ad libitum, and the dog should be encouraged to drink. Ideally, urine specific gravity should be maintained at < 1.020 (4,5). The chance of crystal formation and precipitation increases as the urine becomes more saturated with solutes. If following these recommendations does not prevent crystal formation, the addition of crystal formation inhibitors may be necessary. The most suitable inhibitor for COU is citrate, because it forms a soluble salt with calcium and decreases precipitation (5).
A cat that is fed a fish only diet has ventroflexion and is obtunded. What vitamin deficiency is present?
a) B1
b) A
c) K
d) C
Vitamin B1, fish does not have enough thiamine and also may contain thiaminases especially if raw
What vitamin is thiamine?
vitamin B1
What is the stimulus for the enterocolic reflex?
What is this reflex?
Presence of acid in the duodenum or stomach.
Controls motility of lower GI tract after a meal.
What is the most common cause of a gram negative bacteria causing a chylous effusion in a cat?
a) Klebsiella
b) pseudomonas
c) Pasteurella
d) proteus
Pasteurella
Pyothorax in cats is most often caused by obligate and facultative anaerobes of oropharyngeal origin.
Review: Common drugs in each abx category and their mechanism of action
A Bearman fecal is used to detect…
nematode larvae
What is the likely cause of a hypersensitivity reaction with Elspar
Type 1 so IgE
What is the next step for a cat with splenic MCT?
Splenectomy
What do you see on physical exam when a patient has Horner’s?
Drooping of the eyelids on the affected side (ptosis) The pupil of the affected eye will be constricted/small (miosis) The affected eye often appears sunken (enophthalmos). D/t disruption in sympathetic nerves.
What nerve controls the parasympathetic bladder contraction?
pelvic
What is the MofA of trilostane?
Trilostane inhibits synthesis of cortisol in dogs. It is a competitive inhibitor of 3-beta-hydroxysteroid dehydrogenase, which will interfere with conversion of steroid to cortisol. Inhibition of cortisol is dose dependent and reversible.
What is the best treatment for babesia gibsoni?
Atovoquone and azithromycin
What is a gram positive partial acid fast bacteria?
Nocardia
What is the mechanism of action of amoxicillin?
Inhibition of cell wall synthesis - bacteriocidal
What is the antidote for copper?
D-penacillimin
What is most prognostic with lymphoma?
immunophenotype and response to treatment
How would you cytologically describe estrus?
Sheets and clusters
Cyto: polygonal shaped, multiple nuclei, with anisocytosis and anisokaryosis refers to which of the following?
a) HSA
b) AGASACA
c) Histiocytic sarcoma
d) TCC
Transitional cell carcinoma
Which of the following is associated with perianal fistulas?
a) pemphigus foliaceous
b) colitis
c) atopy
colitis?
What is the MofA of leflunamide?
inhibition of pyrimidine synthesis
What is the treatment for Cytauxoon felis and Tritichomonas felis?
Ranidizole for tritrich?
How can you differentiate on flow between LSA and leukemia?
Can’t for acute or large cell, maybe for small?
Which of the following are B cell markers?
a) CD4
b) CD18
c) CD28
d) CD34
CD 34
What stage do you see morula in a neutrophil?
Acute
What mutation causes hypertrophic cardiomyopathy in maine coons?
A31P mutation in the cardiac myosin binding protein C gene (MYBPC3)
LDDS test question
What attacks MHC class 1
Cytotoxic T cells
What is a chemotherapy that works in metaphase?
Vinblastine?
Which of the following is the appropriate way to treat with antibiotics?
a) treat past clearing the infection
b) change from broad to narrow once you get culture and sensitivity back
c) treat subclinical UTI’s for dogs that have diabetes or cushings
B change from broad to narrow once you get culture and sensitivity back
What is the mechanism of action of pimobendan
It is a calcium sensitizer and a selective inhibitor of phosphodiesterase 3 (PDE3) with positive inotropic and vasodilator effects.
Which of the following chemotherapy drugs are safe for a patient with an MDR1 mutation?
a) CCNU
b) vinblastine
c) doxorubicin
d) Docetaxal
CCNU
What drug route is most affected by first pass metabolism?
a) rectal
b) SQ
c) transdermal
d) IM
e) oral
rectal
What is the most common result of a dog contracting lyme disease?
The dog is fine
How is pythium transmitted?
Through small wounds via contact with water that has zoospores or hyphae
Review: GI hormones
What is the purpose of the JG cells?
Juxtaglomerular cells are responsible for the production, storage, and release of a hormone called renin which regulates blood pressure. They are also called granular cells as they have a large amount of renin-secreting granules. They sense the blood pressure in the arteriole and release an adequate amount of renin
What increases O2 affinity for heme?
temperature, hydrogen ions, carbon dioxide, and intraerythrocytic 2,3-DPG
Review: Calculate accuracy from sensitivity and specificity
What causes the worst VQ mismatch?
PTE?
In which 2 scenarios would O2 not be helpful?
a) pulmonary edema
b) aspiration pneumonia
c) R to L shunt
d) hypoventilation
D?
Review:
Classical pathway, MHC, MAC, Th2, eosinophil, IFNgamma
With babesia, what is the form that ruptures out of the cell?
merozoites
Heparin blocks what? or works on what?
How do cytotoxic T cells destroy cells?
What part of the kidney is affected by aminoglycosides? Sulfonamides?
There were no specific reproduction questions, no questions about what kind of tick is the vector for…, no questions about which breed was most likely (xcept taurine)…
What organ is affected by castor bean toxin?
All but highest in the mucosal regions directly exposed to the toxin.
Where are the following release from and made?
- Aldosterone
- ADH
- Vasopressin
How does iron transport into cells of the intestine?
fe2+ reduced to fe3+ which is then absorbed by DMT1
What protein is copper bound to in order to travel?
Ceruloplasmin
What organ is lactic acid converted in?
Liver
Review: Respiratory graph
Review: Wigger’s diagram (on test had labels)
Given Wigger’s diagram, be able to recongnize isovolumentric relaxation and atrial contraction.
What part of muscle transmits action potentials?
sarcomlema?
What causes a high anion gap acidosis?
increased organic acid in the blood eg lactic acidosis, DKA etc
Which of the following results in hypoventilation?
a) metabolic acidosis
b) metabolic alkylosis
c) respiratory acidosis
d) respiratory alkylosis
metabolic alkylosis?
Dog with jugular pulses, increased CVP, ascites, normal albumin and no murmur has what?
How do you treat it?
Constrictive pericarditis
Pericardial window
Consensus statement on CHF for dogs (Stage A-D): Cavieler KCS with heart murmur of 3-4 no clinical signs, cardiomegaly on thoracic rads?
CVD B2
- remember all Cavie’s at least stage A (high risk of developing heart disease)
ECG from a dog treated with doxorubicin. There is a wide QRS complex with a deep S wave. There is a p present for every QRS. What is the diagnosis?
Right bundle branch block
Which of the following would be expected to be decreased in a patient with pulmonary hypertenstion?
a) prostacyclin
b) nitric oxide
Prostacyclin
Nitric oxide true but wasn’t an answer choice
- PH leads to a deficiency in vasodilators
Which of the following is inactivated in the lungs?
Angiotensin I and bradykinin
- Angiotensin-converting enzyme (ACE) is an enzyme that breaks down and inactivates bradykinin. ACE is present in the lungs and the kidneys and also converts angiotensin I to angiotensin II.
What electrolyte abnormality can cause increased digoxin toxicity?
Hypokalemia (and low Mg, high Ca)
(although digoxin will cause hyperkalemia)
Which of the following heartworm test is more sensitive for the cat than the dog?
a) echocardiogram
b) antigen test
Echo?
Which of the following would cause a hyperdynamic pulse (also termed increased arterial pulse pressure)
PDA and aortic insufficiency
Review: Be able to ID isovolumetric contraction on a pressure volume tracing
What predisposes to endocarditis?
subaortic stenosis
Review: baroreceptor reflex
- stretch sensors in carotids–> stimulates vasomotor sensor –> adjusts BP
- Baroreceptor activation effects increased PO2 or H+ –> increased blood P
What is the most common finding in a 5 month old cat with right sided heart murmur?
VSD is the most common congenital heart disease in a kitten
What is responsible for the S4 sound:
After p wave/atrial contraction, filling against a stiff ventricle
A dog has a second degree AV block that responds to the atropine response test. How do you treat it?
Proapantheline, hycosamine, theophylline/aminophylline
Given an ECG with rapid complexes that are narrow and tall, irregular rhythm, no obvious P wave (baseline looks flat)
Atrial fibrillation
Cavalier King Charles has a grade II murmur, but no changes on rads. What stage of heart disease?
Stage B1
Which is a cause of pulmonary hypertension?
a) pulmonary arteriolar disease (ASD, PDA, VSD, or parasites)
b) Left sided heart disease (MMVD)
c) Pulmonary disease (high altitude, interstitial disease)
d) PTE
e) heartworm disease
MMVD causing backflow into pulmonary circulation
What is responsible for automaticity in the SA node?
Slow Na and Ca channels
What causes increased contractility?
Increased myocardial stretch
- increased extracellular calcium (increased SERCA) - this was also an option and technically right but they were going for stretch (frank-starling)
What is SERCA?
What does it do?
Sarco-endoplasmic reticulum calcium ATPase
- It maintains the low cytosolic calcium level
What are the phases of the cardiac cycle?
Phase 0 - Na upstroke
Phase 1 - K initial repolarization
Phase 2 - plateau Ca
Phase 3 – K repolarization
Phase 4 – RMP
What is the Frank-Starling Law?
The stroke volume of the left ventricle will increase as the left ventricular volume increases due to the myocyte stretch causing a more forceful systolic contraction.
What is perfusion pressure?
Perfusion pressure = Systolic pressure - diastolic pressure
Name 5 cardiac glycosides?
Rhododendron, Lily of the Vally, Foxglove, Oleander, Yew
What degree of AV block do you see on an ECG with no association of the P and QRS
Third Degree
What is the diagnosis for a dog with exercise intolerance and a split S2 heart sound?
Pulmonary hypertension?
What is the diagnosis for a dog with jugular pulses and a right apical systolic murmur?
Portosystemic shunt?
What cardiac abnormality would occur with a left to right PDA?
Dog with progressive exercise intolerance, right sided heart murmur, and inspiratory crackles has what diagnosis?
Idiopathic pulmonary hypertension?
In a patient with a suspected drug reaction what would be the best lesion to biopsy?
Newest lesion, erythematous skin
Older dog with the following thyroid panel: TT4 - high, TSH - high
a) Functional thyroid tumor vs TSH secreting pituitary adenoma vs early thyroiditis
b) immune mediated thyroiditis
Immune mediated thyroiditis?
Older St. Bernard with the following bloodwork: baseline cortisol - low, ACTH - low, cortisol following ACTH stim - low. What is the likely diagnosis?
Secondary hypoadrenocorticism
ACTH stim - baseline cortisol high (92), 4 hours post normal (25, less than 30 is normal), 8 hours post -high (88). What is the most likely diagnosis?
Pituitary dependent hyperadrenocorticism.
What electrolyte abnormality could result in hemolysis following treatment of a patient with DKA?
Hypophosphatemia
Given the following bloodwork: iCa 1.8 (high), PTH normal. What is the diagnosis?
Primary hyperparathyroidism
Nutritional hyperparathyroidism would be associated with which of the following?
Increased renal excretion of phosphorus
This thyroid hormone has the shortest latency period and is quickest to reach maximum cellular activity.
T3
Bloodwork: low chloride (92), Bicarb of 8, K of 5.4, and Na (140). What does this indicate?
Elevation in unmeasured anions?
Hormone responsible for appetite stimulation? Suppression?
Stimulation - ghrelin
Suppression - Leptin
What is the most potent stimulator for aldosterone secretion?
Elevated potassium
What stimulates ADH secretion?
Osmoreceptors in the hypothalamus
What percentage of sodium is reabsorbed in the proximal tubule?
67%
Dog with very high TT4 and high TSH. Diagnosis?
Pituitary tumor?
Interpret a LDDS that shows no suppression at 4 or 8 hours.
Hyperadrenocorticism but you can’t ID which type, most consistent with pdh?
What enzyme in the adrenal cortex is stimulated by ACTH?
Cholesterol desmolase
What inhibits glucogon release?
Somatostatin (also high BG, insulin, FA, ketones
What is the effect of PTH on the kidney?
Calcium reabsorption
What is the ideal diet for a cat with diabetes?
High protein, low carb
What makes glargine so long acting? How about Levemir?
Due to the crystalline formation that allows slow release from SQ over time
Levemir works by binding albumin for slow release
What does hyperthyroidism decrease in order to cause increased GFR?
Total peripheral resistance
- Older cat with DKA; given bloodwork showing severe acidosis, mildly low K, very low Cl, severe hyperglycemia, ketonuria/glucosuria, what do you do first to treat it?
Fluid therapy with 0.9% NaCl
PTH’s influence on bone, kidney, and GI
What would the Ca, phos, and PTH look like in the following scenarios?
Nutritional secondary hyperparathyroidism
Primary hyperparathyroidism
Renal secondary hyperparathyroidism
Increased Ca and P absorption by bone, decrease Calcium and increase phosphorus excretion in kidneys, increases vitamin D activation and GI absorption of both Ca and Phos
Nutritional: low calcium, high phosphorus, high PTH
Primary: high calcium, low phosphorus, high PTH
Renal: low calcium, high phosphorus, high PTH
What are the functions of insulin?
Increase CHO uptake
Increase FA storage
Increase protein synthesis
What is insulin’s influence on the metabolism of adipose tissue
Increase lipoprotein lipase and inhibits hormone sensitive lipase
What is the most common cause of insulin resistant diabetes mellitus in cats
Hypersomatotropism vs hyperadrenocortism?
What endocrine disease causes neuro and cardiac signs as a result of hypertension?
Hyperthyroidism
- Dog with high TSH and high TT4. What is the diagnosis?
Immune mediated thyroiditis
Which of the following can result in hypokalemia?
a) tissue necrosis
b) hyperaldosteronism
What is the effect of calcitonin?
Decrease osteoclast activity
Dog with psychogenic PUPD that you administer desmopressin. What should you worry about?
Hyponatremia
What is the mechanism of action of cardiac glycosides?
blocks Na/K ATPase pump → higher intracellular Na → higher intracellular Ca via the Na/Ca exchange → increased contractility
What is the MofA of a class 4 anti-arrhythmic drug?
Ca channel blockers
What drug should be used for a cat with HCM and LA enlargement?
Atenolol
Review: Types of murmurs for each congenital disease
Where is ANP released from and what are the results?
Released from atria due to increased stretch resulting in naturesis
Staging MMVD in dogs
o Stage A – asymptomatic but predisposed breed (CKCS)
o Stage B1 – structural heart disease but no change in heart function/size on CXR or echo
o Stage B2 – hemodynamic compromise causing radiographic or echocardiographic evidence of left atrial or ventricular enlargement
o Stage C – heart failure, current or previous
o Stage D – end stage/refractory failure
What allows for the automaticity in SA node cells?
Na-Ca channels
What factor most affects blood flow velocity?
Vessel radius
What causes increased cardiac contractility?
Increased intracellular calcium
Increase in _____ will increase cerebral blood flow?
CO2
What causes the action potential plateau in cardiac cells?
Ca influx
What occurs when there is a shift of the O2-hemoglobin curve to the right?
Increased 2,3 DPG, temperature, CO2, H+
Review: Recognizing an AFib ECG, right bundle branch block ECG, atrial standstill ECG, wandering pacemaker ECG
What is the cause for a dog with mild exercise intolerance, muscle wasting, jugular pulses, no murmur, split S2
Pulmonary hypertension
What percentage of hypertensive animals have a cerebrovascular event?
30%
Dog with ascites, increased CVP, jugular distension, normal heart size, normal vessels, normal pulmonary parenchyma on CXR have what heart disease?
cor pulmonae
(right heart failure due to long-term high BP in pulmonary arteries and right ventricle)
What is the goal of diuretics in heart failure therapy?
Decrease preload
What is the treatment of choice for SVT with ventricular tachycardia?
Procainimide
Interpret an ECG with p waves and occasional QRS complexes
AV block
Review: Pressor therapy
o Dopamine – low doses (A1/A2 mediated vasodilation), intermediate (beta-mediated ionotropy), high doses (alpha-mediated vasoconstriction)
o Dobutamine – B1 > B2 > a (inotropy)
o NE – B1 > a > B2 (mild inotropy but also vasoconstriction)
o Epi – B > a (inotropy and vasodilation)
MoA of class 1 anti-arrhythmics?
Class 2?
Na channel blockers
Beta blockers
Review: Phases of cardiac action potential
o 0 – Na channels open, depolarization
o 1 – initial rapid repolarization and Na closure
o 2 – plateau with Ca opening
o 3 – final repolarization to RMP (close Ca, open K)
o 4 – RMP
What is a PDA?
Patent Ductus arteriosis - communication between aorta and pulmonary artery
What receptors are affected by dobutamine
B1>B2>alpha 1
What is the most common location of aortic stenosis?
Subvalvular
What are the target organs for hypertension?
Eyes, heart, brain, kidneys
What is the effect of epinephrine on the pupils, lungs, vessels
Mydriasis, bronchodilation, vasodilation (beta 2 receptors)
What does endothelin cause?
What about bradykinin?
Vasoconstriction
Vasodilation
What are some of the effects of nitroglycerin?
Coronary dilation, decrease preload by increasing venous capacitance, reflex tachycardia
Review: heartworm testing in cats. What is the most sensitive test? What is the most specific?
Antibody testing has increased sensitivity - good screening test (Sn 88%, Sp 90%)
Antigen testing has high specificity - used to confirm positive result (Sn <40%, Sp 100%) but only detects femail worms, mature worms.
What do carotid body receptors react to?
Hypoxia
What arrhythmia is seen during infusion of doxycycline?
Sinus arrhythmia with right bundle branch block
Do purkinje cells have automaticity?
As part of the conduction system, the Purkinje cells have potential (or normal) automaticity, which is normally suppressed by the faster pacemaker activity of the sinoatrial node.
Review: Diuretics MofA and where they act?
loop diuretics (loop of Henle, Na/K/2Cl transporter), thiazide (early distal tubule, Na/Cl transporter), carbonic anhydrase inhibitors (proximal tubule), K sparing diuretics (spironolactone, aldosterone antagonist at late distal tubule and collecting duct)
MofA of Mannitol
Osmotic diuretic; freely filtered at glomerulus and poorly reabsorbed in tubule which prevents water reabsorption
What is the Cushing’s reflex a response to? What is it?
Inceased intracranial pressure
Hypertension with reflex bradycardia
Which of the following is NOT true about angiotensin II activity?
a) decrease central vein capacitance
b) vasoconstrictor, increase aldosterone,
c) release of NE from postganglionic nerve, increase ADH)
a) decrease central vein capacitance ?
What is the initial treatment for perianal fistula?
Cyclosporine
Pemphigus foliaceous affects what level of the skin?
Stratum corneum
What does pemphigus vulgaris cause?
What other disease mimics this?
vesicobullous lesions in oral cavity/mucous membranes
Erythema multiforme
What causes superficial necrolytic dermatitis
Most often due to hepatovacuolar disease (glucagonoma in people) and phenobarbital use
What lesion is caused by rocky mountain spotted fever?
Vasculitis
What hormones affect sebum production?
Androgens and thyroid hormone
What is the name of the antigen presenting cells in the skin?
Langerhans cells
What layer of skin protects against drug absorption?
Stratum corneum
Which type of hyperadrenocortiscm will never suppress?
What percentage of the other will have a transient 4 hour suppression?
Adrenal dependent
30% of pituitary dependent
Why does hyperthyroidism cause PUPD?
Increased metabolic rate, increased renal blood flow, and increased GFR
Patient presents with dullness, stupor, disorientation, possible seizure. What complication from an endocrine disease is most likely?
Myxedema coma
What endocrine disease other than diabetes can cause peripheral neuropathy?
Hypothyroidism - can see weakness, ataxia, CP deficits, and CN abnormalities (facial paralysis)
What is activated with ACTH is bound to the adrenal receptor?
Adenyl cyclase (results in cresase in cAMP)
What is SIADH?
What does it cause?
What will happen to GFR?
Syndrome of inappropriate antidiuretic hormone secretion
Body makes to much ADH (vasopressin) and retains water
GFR does not change
A patient has increased calcium, normal to increased PTH, normal to low phosphorus, and normal to increased calcitriol. What is the cause of these changes?
Primary hyperparathyroidism
Other than electrolyte abnormalities, what other change can you see on chemistry for a patient with Addison’s?
Cholesterol can be low
What makes secondary Addition’s different from primary?
In secondary, there is a problem in the pituitary leading to low ACTH production
Nutritional hyperparathyroidism is secondary to excretion of what electrolyte in kidney diesease
Phosphorus
Where is vasopressin (ADH) formed and secreted
Formed in the supraoptic nuclei of the hypothalamus and secreted by posterior pituitary
What is the mechanism of hypoglycemia with Addison’s disease
Increased sensitivity of insulin receptors
Review: Given ACTH and cortisol levels be able to diagnose Addison’s disease
What is the effect of T4 on the cardiovascular system?
Decreases vascular resistance, upregulates beta receptors (leading to tachycardia and increased contractility)
What is the difference between how peptide hormones and steroid hormones are stored and used.
Peptide: short acting, stored in vesicles and released for rapid response
Steroid: Stored in small amounts and mostly made on demand from precursors, longer half life
When monitoring a patient on Lysodren for treatment of Cushings, what test should you use and what value should it be?
ACTH stim, aim for post value less than 5
What are some of the functions of somatostatin?
What stimulates its secretion?
- Inhibits insulin secretion, glucagon secretion, pancreatic polypeptide secretion, gastric emptying, gastric acid secretion, and GH secretion
- Stimulated by increased GH, glucose, amino acids, CCK
What is the generic name for Lysodren? Vetoryl?
What is the mechanism of action of Lysodren?
Mitotane = Lysodren, trilostane = Vetoryl
MofA - inhibits 3 beta hydroxysteroid dehydrogenase preventing release of cortisol
What electrolyte abnormalities can you see with DKA and how to treat?
Low, K, P, Na; initially treat with 0.9% NaCl and may need to supplement dextrose as BG falls quickly.
How can you get a false negative fructosamine?
Hypoproteinemia, canine hyperlipidemia, feline hyperthyroidism
In an acromegalic patient, what is the best way to measure growth hormone levels?
IGF-1 levels
What is a major side effect of treatment with growth hormone?
Development of diabetes mellitus
Where is calcitonin secreted from and what does it do? via what MofA?
From C-cells of the thyroid gland. It inhibits reabsorption of Ca and P, increases the excretion of Ca. Works by inhibition of osteoclasts.
What is the somogyi phenomenon and how long can it last?
How do you treat?
It occurs when hepatic glycogenolysis appens and results in hyperglycemia. It can last for up to 72 hours and you need to decrease insulin and may need to use a longer acting insulin.
What changes in lipoprotein complexes can you see in a diabetic patient?
- decreased LPL and increased HSL activity - releases triglycerides from storage resulting in increased VLDL production from the liver
- Increased cholesterol synthesis leads to down regulation of LDL receptor and increased circulating LDL/HDL
What is the most common cause of high phosphorus in veterinary patients?
Renal disease
What is the MofA of methimazole?
It blocks thyroid hormone synthesis by inhibiting thyroid peroxidase, inhibiting conversion of iodid to iodine
With low albumin what electrolyte will also be low?
Calcium
What is the cause of hyperaldosteronism and what electrolyte abnormalities and clinical signs will you observe?
Tumor of zona glomerulosa
Low K, P, Mg, Na can be normal/high, acidosis
Hypertension, PUPD with volume expansion
What drugs can interfere with thyroid testing results?
Phenobarbital, steroids, TMPS, carprofen, etc.
Explain Vitamin D metabolism.
7-dehydrocholesterol is converted (sunlight used to break one of the rings) to previtamin D3. It isomerizes to form cholecalciferol (vitamin D3) which is hydroxylated to form 23(OH)D3 (calcidiol). In the liver calcidiol is bound to vitamin D binding protein and transported to the kidnyes were an enzyme converts it to 1,25(OH)2D3 (calcitriol) which is the active form of vitamin D.
How to stepwise figure out what type of AV block you have based on ECG. Ask yourself, are the P waves and QRS compleses consistently and reasonably related?
a) Normal, constant PQ interval
b) No consistent relationship between P and QRS
c) Some p waves are not followed by QRS
d) Long P-Q interval
Tell the story:
a) sinus rhythm
b) 3rd degree
c) 2nd degree
d) 1st degree
P wave = wife, QRS = husband
First degree AV - Husband always comes home. Comes home LATE but always comes home.
Second degree - Your husband doesn’t always come home
– Mobitz type 1: He comes home later and later until he doesn’t come home at all.
– Mobitz type 2: He sometimes comes home and sometimes doesn’t, but when he does it is at the same time.
Third degree - The husband and wife are no longer talking so they are on completely different schedules. Without going to therapy/a pacemaker result in marriage (heart) failure.
What is the most specific enzyme for cholestasis?
GGT
What is the strongest stimulus for release of pancreatic enzymes?
Presence of chyme in the duodenum leads to acheolene release from parasympathetic system leading to CCK and secretin release
What electrolyte is important for absorption of glucose in the intestines through the SGLT1 channel?
Sodium
What hormone is activated by protein, fat, and increased intestinal osmolality?
CCK
What vitamin does intrinsic factor help with absorption of? Where is intrinsic factor made?
B12, dog - pariatel cells and pancreas, cat - pancreas
What hormones are secreted by the fasting dog
Motilin, gastrin, pancreatic polypeptide
What virus attacks the crypt and which ones attack the villi of the intestines?
Crypt - parvo
Villia - coronavirus, rotavirus, cryptococcus
What are the 4 different types of diarrhea and give an example of each?
Secretory - bacterial endotoxins, bile acids/fatty acids from bacteria, giardia, enteritis
Osmotic - malabsorption, diet change, lactulose
Permeability/exudative - enteritis, ulceration, infiltration, lymphatic obstruction
Dysmotility - hyperthyroidism
What is the most sensitive test to diagnose chronic pancreatitis in the cat? What is the most specific test for acute pancreatitis?
abdominal ultrasound
fPLI
Anorexic cat with a very high ALP and an elevated GGT. What is the diagnosis?
Hepatic lipidosis?
